Magister Public Health - MPH / Background: Adherence of patients on antiretroviral therapy to lifelong treatment is a major challenge within the public health system in Namibia. Missed appointments have been shown to contribute to poor clinical outcomes and treatment failure, which may necessitate switching to more expensive antiretroviral regimens. In resource limited settings monitoring of appointments for antiretroviral medication pick up is a documented and feasible method for assessing minimum levels of adherence to antiretroviral medication. Aim: This study was aimed at evaluating the effects of telephonic short message service reminders influence on adherence to scheduled antiretroviral medication pick up appointments. It was also aimed at evaluating how socio-demographic parameters might moderate the effectiveness of short message service reminders. Study design: A randomized double blind controlled study design was employed. Methodology: Stable patients attending the ART clinic were recruited and randomly assigned to either an intervention or control group, until the sample size of 398 was reached in the two arms of the study. The study populations were adult patients’ ≥ 18 years who have been enrolled on treatment for ≥ 3months. The intervention group received an unasked for single short message service reminder, sent 48 hours before their scheduled appointments and continued with standard care, while the control group received standard care without any reminder. The study participants were blinded to their study group. Also, research assistants involved in collecting baseline and outcome data were blinded to study participants study group. Baseline data was collected through a structured questionnaire. Study participants were followed up for four consecutive scheduled ARV pick up appointments. The following outcome data were collected at each follow up visit; number of days late after scheduled appointment, adherence measured by pill count and 3 days self-report recall of adherence. Main results: The pre-intervention survey revealed that only 60% of the study participants were willing to be reminded of their medication pick up appointment. Overall, the SMS reminder improved adherence to medication pick up appointments by 1.6 times as compared to no reminder and also reduced the risk of missing medication pick appointments by 22% as compared to no SMS reminder. Study participants that received a reminder were also two times more likely to achieve optimal adherence to their medication, compared to those who received no reminder. The SMS reminder improved adherence to antiretroviral medication by 11% in this study, while the mean difference in the number of days late to collect antiretroviral medication was significantly reduced by about 4 days by the intervention. Participants that are employed were more likely to adhere to antiretroviral medications as compared to the unemployed. Ironically participants that were on ART for less than one year and those that had treatment supporters reminding them of their medication appointments were significantly less likely to honour their medication pick up appointments. Conclusion: Being employed was significantly associated with attaining optimal adherence to antiretroviral medication. There were no other significant associations between the patients socio- economic and demographic characteristics and adherence to scheduled medication pick up appointments, or to adherence to medication. Recommendations: The Ministry of Health and Social Services should consider rolling out SMS reminders to ART sites with similar settings as Swakopmund State Hospital ART Clinic. Patients that are willing to receive the reminder should be targeted in the scaling up of the roll out. Late and missed medication pick up appointments could be used as an easy proxy measurement for assessing adherence to ART.

Adherence to ARV medicines is essential to halt HIV progression, increase CD4 counts, decrease virologic impact, and improve quality of life for the infected people. However, sustaining good adherence among adolescents and young adults (AYA) has been a challenge caused by various problems such as distance to clinic, improved CD4 count which lead to complacency in adherence, and the nature of the environment. This was a quantitative, retrospective, correlational, cross-sectional study anchored by the transtheoretical model, which was used to understand how adherence rate among the study population was impacted by the predictive factors. Secondary data was collected from patient's medical records at the Federal Medical Center, Makurdi in Benue State, Nigeria. Univariate analysis was conducted using descriptive statistics. The study sample size of 656 patients was drawn from AYA ages 15-24 years. Independent t tests showed a statistically significant difference in adherence rates between rural (94%) and urban (89%) AYA, t (424) = -3.280, .001, p -?¤ .05. There was also a statistically significant difference in adherence rates of ART for patients who lived within 50 kilometers of the hospital and those who lived more than 50 kilometers away from the hospital, t (509) = -2.37, .018, p -?¤ .05. Also, there was a statistically significant correlation between adherence rate to ART and CD4 of less than 500 cells/mm3, R = .214, NS = .003, p -?¤ .05. This study provides findings for HIV implementing partners (IPs) and relevant health professionals in Nigeria useful for designing strategies that would improve adherence rate to antiretroviral therapy among AYA in Nigeria.

Adherence to antiretroviral therapy is crucial to ensure viral suppression. In the scientific community it is widely accepted that an adherence level of at least 90% is necessary to achieve viral suppression. This study uses pharmacy refill records to describe antiretroviral adherence in HIV-positive patients in Ugu District and to describe pharmacy refill records as reliable monitoring method of antiretroviral therapy. In total, 61 patients’ records were reviewed. Overall, 82% of participants (n=50) achieved an optimum adherence level of at least 90%. Although 38% (n=19) of these participants did not show any related viral suppression. A statistically significant relationship between adherence and viral suppression was not demonstrated. Therefore, pharmacy refill records cannot be recommended as an alternative method of monitoring response to antiretroviral therapy, but laboratory tests including CD4 cell count and or viral load must be combined to pharmacy refill method for monitoring of antiretroviral therapy in HIV-positive patients / Health Studies / M.A. (Public Health)

Adherence to antiretroviral therapy is crucial to ensure viral suppression. In the scientific community it is widely accepted that an adherence level of at least 90% is necessary to achieve viral suppression. This study uses pharmacy refill records to describe antiretroviral adherence in HIV-positive patients in Ugu District and to describe pharmacy refill records as reliable monitoring method of antiretroviral therapy. In total, 61 patients’ records were reviewed. Overall, 82% of participants (n=50) achieved an optimum adherence level of at least 90%. Although 38% (n=19) of these participants did not show any related viral suppression. A statistically significant relationship between adherence and viral suppression was not demonstrated. Therefore, pharmacy refill records cannot be recommended as an alternative method of monitoring response to antiretroviral therapy, but laboratory tests including CD4 cell count and or viral load must be combined to pharmacy refill method for monitoring of antiretroviral therapy in HIV-positive patients / Health Studies / M.A. (Public Health)